Provider Demographics
NPI:1073785820
Name:MEADOWS, AMON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMON
Middle Name:A
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4686 S ATLANTA RD SE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7080
Mailing Address - Country:US
Mailing Address - Phone:404-799-8499
Mailing Address - Fax:404-799-8496
Practice Address - Street 1:4686 S ATLANTA RD SE
Practice Address - Street 2:SUITE I
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7080
Practice Address - Country:US
Practice Address - Phone:404-799-8499
Practice Address - Fax:404-799-8496
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00772461DMedicaid